SHOESMART: Danielle Tolbert tries on a pair of running shoes in Philadelphia. After years of runners trying to find shoes that help correct problems, experts are now recommending to just find a pair that is comfortable.

By Melissa Dribben

Wondering about the best shoes to wear for workout?
Neutral? Minimalist? Stability? Motion control? Cushioned heel?
Confused? Of course you are. Well, sports medicine specialists have good news. Stop worrying about fallen arches, overpronation, and putting your feet on a paleolithic regimen.
The latest thinking about how to choose the best running shoe is to let comfort be your guide. Since the 1970s, running shoes have evolved from puny slabs of rubber sewn to canvas shells into engineering feats rivalling 3-D-printed surveillance drones.
Far beyond the latest Nike Flyknit Lunar 2 are plans for running shoes made of computer-generated molecules that will link to living organisms and conform to your foot’s ever-changing needs. In the somewhat-less-distant future are Google Bluetooth-enabled shoes that talk to you and tell you how your run is going.
For now, runners have a hard enough time picking from hundreds of mute, inorganic options. “Historically, the push has always been to look at foot pronation,” said Bryan Heiderscheit, a professor in the department of biomedical engineering at the University of Wisconsin-Madison.
Runners were told to wear shoes that would correct for the foot’s tendency to roll inward or outward, on the theory that this would correct biomechanical flaws and prevent injuries to the knees and lower back. “But the best studies that have been done in the last 10 years,” said Heiderscheit, “have not substantiated that claim.”
In 2010, the American Journal of Sports Medicine published a study of 1,400 Marine Corps recruits. Half the group was given shoes based on a careful evaluation of the shape of their feet. The control group’s shoes were chosen randomly. “Assigning shoes based on the shape of the plantar foot surface,” the authors concluded, “had little influence on injuries.”
When Heiderscheit tries to explain this to members of the running-shoe industry, he gets “pushback.” Not surprising, he said, considering that the $20bn athletic-shoe market sustains itself on innovation. Most companies release new models twice a year, offering features designed to improve performance and prevent injury.
The idea that almost any shoe is fine if it’s comfortable is also apt to meet resistance from runners for whom theory has become dogma. Believers in barefoot running or minimalist shoes, for instance, are unlikely to be convinced.
Both are fine, said Heiderscheit, as long as recent converts do not make the switch too abruptly. Speaking from personal experience, Heiderscheit said, it is easy to get injured if you decide to toss your cushiony sneakers and immediately start racking up miles in a pair of barely-theres.
It can take months to adapt, he said. He recommends exercises to strengthen muscles in the calf and foot and using the minimalist shoes for short, easy runs at first.
“You should feel so comfortable in a shoe that you could sleep in them,” said Jon Woo, a sports medicine specialist at the University of Washington in Seattle.
Experts say that just as everyone’s feet are unique, so are their running styles. “There is no absolute biomechanical ideal,” said Heiderscheit.
One of the world’s fastest marathoners, Pescah Jeptoo, has a knock-kneed gait that has carried her through 26.2 miles in a blazing two hours, 20 minutes, and 14 seconds.
Still, Heiderscheit said, there are “flaws” to avoid.
“You don’t want to bounce too much. You don’t want to overstride. And the one thing we absolutely don’t want people to do is a hard heel strike — truly coming down on your heel with your foot pointed high in air.”
Jeptoo, for the record, runs in Nike Zoom Streak 3s, a lightweight, breathable shoe with some support and cushioning. Online reviews of the shoe range from “I got huge blisters” to “Perfect!”
If this proves anything, experts said, it is that the one true authority on which shoes are best is the runner who wears them.
“That sounds about right,” said Danielle Tolbert.
Nine days before her first time tackling Philadelphia’s Broad Street Run, Tolbert, a 37-year-old trade specialist, went to Philadelphia Runner on Sansom and 16th Streets to buy a new pair of running shoes.
Before pulling out shoes for Tolbert to try on, the saleswoman, Liz Foster, asked her to take a walk so she could evaluate her gait. Foster, who is a serious runner herself, agrees that comfort is the overriding factor. But she rejects the notion that shoes do not prevent injuries.
“Anecdotally, I’ve seen a lot of injuries from bad shoes,” she said. Runners who come to her complaining of knee and ankle pain get the proper shoes and return six months later feeling better.
“Try these,” she said, loosening the laces on a pair of Sauconys for Tolbert. “This is going to feel much different.”
For 10 weeks, Tolbert had been training for the race in Adidas Energy Boosts, which she’d bought online after getting recommendations from fellow members of her running group, Black Girls Run. But then her ankles started hurting.
After trying on half a dozen brands and styles and testing them on the store’s treadmill, Tolbert chose a pair of Mizuno Wave Paradoxes. “I bought them,” Tolbert said, “because they felt the most comfortable.”  — The Philadelphia Inquirer/MCT


Too many doctors are prescribing
antibiotics in error, study says
About 7 in 10 patients in the US who go to a doctor seeking treatment for acute bronchitis wind up leaving their appointment with a prescription for an antibiotic, according to a new study in the Journal of the American Medical Association. That’s a problem, the study authors say, because the ideal prescription rate should be 0%.
That’s right, a big fat zero. Zip. Nada. Zilch. More than 40 years of clinical trials have demonstrated that antibiotics do not help patients with acute bronchitis. On top of that, the Centers for Disease Control and Prevention have been emphasising this fact for the last 15 years, as has the Healthcare Effectiveness Data and Information Set for nearly 10 years, the JAMA report says.
But it doesn’t seem that the message has gotten through to doctors. Not only are physicians continuing to write prescriptions for the medications, but they also did it more frequently in 2010 than they did in 1996, the study authors found.
Researchers from Brigham and Women’s Hospital in Boston analysed data from two US national surveys that track patients who are seen in medical clinics (including paediatric practices) or in hospital emergency departments. Records between 1996 and 2010 identified 3,153 patients whose only medical complaint was acute bronchitis, a respiratory disease that makes people cough and is over in less than three weeks. (Patients who also had other problems, including chronic pulmonary disease or infectious diseases, were excluded from the analysis.)
During the entire study period, 36% of those patients got a prescription for an extended macrolide, a group that includes such workhorses as azithromycin and erythromycin. Another 35% got an Rx for a broad-spectrum antibiotic, including fluoroquinolones, aminopenicillins and cephalosporins. Altogether, the antibiotic prescription rate was 71%, the researchers found.
Use of the broad-spectrum drugs fell slightly during the study period, though the difference wasn’t large enough to be statistically significant, the researchers reported. However, there was a distinct rise in the use of extended macrolides, with the prescription rate increasing from 25% between 1996 and 1998 to 41% between 2008 and 2010, according to the study. Over the 14 years of the study, 72% of doctors in primary care practices gave their patients some kind of antibiotic for acute bronchitis. So did 69% of the doctors treating patients in hospital emergency departments. Both groups of physicians seemed to lay off the drugs a little bit between 1999 and 2001, but that trend didn’t last.
The study authors sounded somewhat exasperated about the fact that a figure that should be 0% was actually 71%. “Avoidance of antibiotic overuse for acute bronchitis should be a cornerstone of quality health care,” they wrote.
The CDC and other health groups are concerned that the overuse of antibiotics is helping to fuel the rise in drug-resistant pathogens, including strains of tuberculosis, Staphylococcus aureus and E. coli. This month, one of the World Health Organisation’s top officials for health security warned that “the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.”
“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier and benefit from modern medicine,” said Dr Keiji Fukuda, who led a report on the state of antimicrobial resistance around the world. “Unless we take significant actions ... the implications will be devastating.” -- By Karen Kaplan, Los Angeles Times/MCT